Muller Arno, Mauny Frédéric, Talon Daniel, Donnan Peter T, Harbarth Stephan, Bertrand Xavier
Service d'Hygiène Hospitalière et d'Epidémiologie moléculaire, Centre Hospitalier Universitaire Jean Minjoz, 25030 Besançon, France.
J Antimicrob Chemother. 2006 Oct;58(4):878-81. doi: 10.1093/jac/dkl343. Epub 2006 Aug 18.
To observe the relative role of individual and group-level antimicrobial selective pressure on subsequent methicillin-resistant Staphylococcus aureus (MRSA) isolation in a university hospital.
For this purpose, 18 596 patients were included in a retrospective statistical analysis, applying multilevel modelling with discrete time intervals at the lowest level. Individual-level and hospital group variables on antimicrobial exposure and MRSA colonization pressure were collected from computerized databases.
The simultaneous hospital group- and individual-level analysis showed individual exposure to fluoroquinolones and collective exposure to penicillins to be associated with MRSA isolation after adjustment for colonization pressure and other potential confounders.
These results support efforts to reduce prescriptions of selected antimicrobial drug classes such as fluoroquinolones and show the added value of multilevel analysis for research on the adverse outcomes of antibiotic prescribing.
观察个体和群体层面的抗菌药物选择压力对大学医院后续耐甲氧西林金黄色葡萄球菌（MRSA）分离的相对作用。
为此，对18596名患者进行回顾性统计分析，在最低层面采用离散时间间隔的多层次建模。从计算机数据库收集个体层面和医院组关于抗菌药物暴露和MRSA定植压力的变量。
同时进行的医院组和个体层面分析表明，在调整定植压力和其他潜在混杂因素后，个体接触氟喹诺酮类药物以及群体接触青霉素类药物与MRSA分离有关。
这些结果支持减少氟喹诺酮类等特定抗菌药物类别处方的努力，并显示了多层次分析在抗生素处方不良后果研究中的附加价值。
